Comorbidity Burden and Biologic Access in an Uninsured Psoriasis Population: A 20-Year Descriptive Study

Area of Science:

• Dermatology
• Public Health
• Health Equity

Background:

• Psoriasis is a chronic immune-mediated disease often accompanied by systemic comorbidities.
• Biologic therapies are effective for moderate-to-severe psoriasis but are costly, posing barriers for uninsured individuals.
• A dedicated safety-net program was established to improve access to dermatologic care for underserved populations.

Purpose of the Study:

• To characterize the comorbidity burden in indigent patients with moderate-to-severe psoriasis.
• To describe the structure and function of a safety-net program providing biologic access.
• To inform future health system initiatives focused on health equity in psoriasis care.

Main Methods:

• A descriptive retrospective cohort study of 450 patients with moderate-to-severe psoriasis receiving biologic therapy through a safety-net program (2005-2025).
• Data collected via electronic medical records and intake questionnaires included demographics and comorbidities.
• Descriptive statistics were used; clinical outcome measures were not assessed.

Main Results:

• Nearly half of the patients (49.8%) had at least one systemic comorbidity, including psoriatic arthritis (35.1%), hypertension (31.3%), and diabetes (20%).
• Higher-than-expected frequencies of infectious diseases were observed, such as hepatitis B/C (3.8%), latent tuberculosis (3.6%), and HIV (2.7%).
• The safety-net model utilized standardized screening, referral pathways, and multidisciplinary coordination for biologic access.

Conclusions:

• This 20-year study highlights the significant comorbidity and infectious disease burden in an indigent psoriasis population.
• The findings describe a functional care delivery framework for improving biologic access within a safety-net setting.
• The study provides insights for developing health system and health equity initiatives for underserved psoriasis patients.